Background
Methods
Data sources
Statistical analysis
Results
Clinical reading (n = 1781) | Optimized interpretation (n = 1777) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variables† | n (%) | Disease prevalence n (%) | Sensitivity % | Specificity % | Positive likelihood ratio | Negative likelihood ratio | Sensitivity % | Specificity % | Positive likelihood ratio | Negative likelihood ratio |
HPV test | ||||||||||
Positive | 537 (30) | 282 (53) |
95
|
76
|
4.02
|
0.07
|
92
|
76
|
3.93
|
0.10
|
Negative | 1244 (70) | 73 (6) |
64
|
93
|
9.31
|
0.38
|
64
|
93
|
8.85
|
0.38
|
Study setting | ||||||||||
Screening | 1320 (74) | 70 (5) |
70
|
94
|
12.32
|
0.32
|
75
|
92
| 8.96 | 0.27 |
Referral clinic | 461 (26) | 285 (62) |
93
|
60
|
2.34
|
0.12
|
89
|
77
| 3.90 | 0.14 |
Age | ||||||||||
<35 years | 981 (55) | 158 (16) | 89 |
92
|
11.66
| 0.12 | 83 |
91
| 9.44 | 0.19 |
≥ 35 years | 800 (45) | 197 (25) | 88 |
87
|
6.79
| 0.14 | 89 |
88
| 7.37 | 0.12 |
Current smoking | ||||||||||
Yes | 602 (34) | 161 (27) | 90 |
88
| 7.22 | 0.11 | 87 | 89 | 7.67 | 0.15 |
No | 1161 (66) | 188 (16) | 87 |
91
| 9.98 | 0.14 | 87 | 90 | 8.94 | 0.15 |
European origin | ||||||||||
Yes | 1623 (91) | 312 (19) | 88 |
91
|
9.71
| 0.13 | 87 | 90 |
8.81
| 0.15 |
No | 158 (9) | 43 (27) | 91 |
81
|
4.74
| 0.11 | 83 | 86 |
5.99
| 0.19 |
Educational level | ||||||||||
< Higher | 1063 (60) | 227 (21) | 88 |
87
|
7.15
| 0.14 | 87 |
88
| 7.31 | 0.15 |
≥ Higher | 709 (40) | 128 (18) | 89 |
93
|
14.38
| 0.12 | 86 |
92
| 11.06 | 0.15 |
Postmenopausal | ||||||||||
Yes | 174 (10) | 44 (25) | 86 | 88 | 7.49 | 0.15 | 93 | 91 | 10.09 | 0.08 |
No | 1607 (90) | 311 (19) | 89 | 90 | 9.13 | 0.12 | 85 | 90 | 8.31 | 0.16 |
Contraception | ||||||||||
None | 640 (36) | 127 (20) | 89 | 89 | 8.30 | 0.12 |
87
| 90 | 8.93 | 0.14 |
Combined oral pill | 905 (51) | 173 (19) | 87 | 91 | 9.26 | 0.14 |
83
| 90 | 8.50 | 0.19 |
Others | 236 (13) | 55 (23) | 91 | 91 | 9.68 | 0.10 |
96
| 87 | 7.27 | 0.04 |
Univariable analyses | Multivariable analyses | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Clinical reading | Optimized interpretation | Clinical reading | Optimized interpretation | |||||||||||||
Sensitivity Specificity† | Likelihood ratios‡ | Sensitivity Specificity† | Likelihood ratios‡ | Sensitivity Specificity† | Likelihood ratios‡ | Sensitivity Specificity† | Likelihood ratios‡ | |||||||||
Variables | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction | Main effect | Interaction |
HPV test | <0.001 | 0.03 | <0.001 | 0.033 | <0.001 | 0.18 | <0.001 | 0.18 | <0.001 | 0.09 | <0.001 | 0.011 | <0.001 | 0.15 | <0.001 | 0.17 |
Study setting | <0.001 | 0.10 | 0.001 | 0.11 | <0.001 | - | 0.023 | - | <0.001 | 0.14 | 0.015 | - | <0.001 | - | ||
Age | 0.001 | 0.06 | - | 0.07 | 0.04 | - | 0.12 | - | 0.026 | - | 0.045 | - | 0.047 | - | ||
Current smoking | 0.03 | - | - | - | - | - | - | - | ||||||||
European origin | <0.001 | - | - | - | 0.17 | - | - | - | ||||||||
Educational level | <0.001 | 0.035 | - | 0.043 | 0.014 | - | - | - | ||||||||
Postmenopausal | - | - | - | - | - | 0.17 | - | - | ||||||||
Contraceptive status | - | - | - | - | - | - | - | - |
Discussion
Study, Year | Approach to the analysis of spectrum bias/effect | Disease (number of subjects) | Diagnostic or screening test | Factors investigated | Effect on sensitivity and/or specificity | Effect on Likelihood ratios |
---|---|---|---|---|---|---|
Van der schouw, 1995 [5] | Subgroup analysis | Epididymitis (372) | Ultrasonography | Disease prevalence (severity according to clinician) | Disease prevalence (severity according to clinician) | Disease prevalence (severity according to clinician) |
Morise, 1995 [36] | Subgroup analysis | Coronary disease (4467) | Exercise electrocardiography | Sex Verification by the gold standard (angiography) or not | Sex Verification bias by the gold standard (angiography) or not | Not considered |
O'Connor, 1996 [6] | Subgroup analysis | Multiple sclerosis (303) | Magnetic resonance imaging and evoked potentials | Study group (two pooled studies considered), disease prevalence, clinical subjective disease probability | Study group, disease prevalence, clinical subjective disease probability | Not considered |
Egglin, 1996 [37] | Subgroup analysis | Pulmonary embolism (24) | Pulmonary arteriogram | Disease prevalence | Disease prevalence | Not considered |
Roger, 1997 [8] | Subgroup analysis | Coronary disease (3679) | Exercise echocardiography | Sex | Sex | Not considered |
Curtin, 1997 [7] | Subgroup analysis | Obesity (226) | Body mass index | Weight, sex | Weight, sex | Not considered |
Moons, 1997 [9] | Subgroup analysis and modelling of sensitivity | Coronary disease (295) | Exercise test | Patient history and clinical examination, various disease-related factors (maximal load, relative load, systolic blood pressure, number of diseased vessels) | Sex, expected load, maximal load, relative load, systolic blood pressure (baseline and peak), number of diseased vessels | Age, sex, symptoms, smoking, beta blocker use, cholesterol level, expected load, maximal load, relative load, systolic blood pressure (baseline and peak) |
Santana-Bodao, 1998 [38] | Subgroup analysis | Coronary disease (702) | Single-photon emission computed tomography | Sex | Sex | Not considered |
Steinbauer, 1998 [10] | Subgroup analysis | Alcohol abuse (1333) | Various screening tests | Race and sex | Race and sex | Race and sex |
DiMatteo, 2001 [39] | Subgroup analysis | Group A beta haemolytic streptococcal pharyngitis (498) | Rapid antigen detection test | Disease severity | Disease severity | Not considered |
Filly, 2002 [48] | Subgroup analysis and modelling | Cirrhosis (100) | Nodularity of surfaces of the liver | Deep versus superficial surfaces | Deep versus superficial surfaces | Age, sex, pathological type of cirrhosis |
Hall, 2004 [40] | Subgroup analysis and modelling | Group A beta haemolytic streptococcal pharyngitis (561) | Rapid antigen detection test | Disease severity | Disease severity | Not considered |
Meideros, 2005 [49] | Subgroup analysis | Glaucoma (136) | Scanning laser polarimetry | Two forms of glaucomatous optic neuropathy | Two forms of glaucomatous optic neuropathy | Two forms of glaucomatous optic neuropathy |